| NPI | 1407503238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY C MARSHALL JOHNSON Counselor/Owner 260-444-7200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2022-03-02 |
| Last Update Date | 2022-03-02 |